Tracy Carruth
Behavior Technician in Boise, ID. Individual provider (NPI-1).
NPI number1982304507
StatusActive
Last updated in NPPESMar 3, 2023
Details
- NPI
- 1982304507
- Entity type
- Individual (NPI-1)
- Name
- Tracy Carruth
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 3, 2023
- Certification date
- Mar 3, 2023
- Last updated
- Mar 3, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
4232 N Waterford PlBoise, ID 83703-3490
Phone 208-871-2102
Mailing address
4232 N Waterford PlBoise, ID 83703-3490
Phone 208-871-2102
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